EDI Claims Information

July 8, 2021: The Board has established a new mailbox EDI.WCB@maine.gov specifically for questions about electronic data interchange rejections and errors:

• For electronic claims related inquiries (First Reports and Denials), please include the JCN/WCBN (DN5) and/or Claim Administrator Claim Number (DN15) along with the Policy Number Identifier (DN28) with no dashes, spaces, etc.

The forms below have fb88 specific information for EDI claims data elements based on IAIABC standards for Claims Release 3.

Any new trading partner must fill out the Trading Partner Documents as the first step in the testing process.

Event Table (Excel Spreadsheet)- The Event Table contains claim events for reporting FROI and SROI Denials to the fb88 Workers' Compensation Board, Maintenance Type Codes for events and circumstances under which a FROI and SROI Denial should be sent.

Element Requirement Table (Excel Spreadsheet)- The Element Requirement Table contains a list of data elements that are required for submission of a FROI and SROI Denial.

Edit Matrix Table (Excel Spreadsheet)- The Edit Matrix Table includes applied editing based on the IAIABC standards and fb88's FROI and SROI Denial data requirements.

Implementation Guides

The fb88 WCB Claims Implementation Guide (Word Document) is provided to assist Claim Administrators, Insurers and Self Insures with fb88 specific information regarding Electronic Data Reporting to the State of fb88 Workers Compensation Board.

An IAIABC Claims R3 Implementation Guide can be purchased and downloaded from the . The guide provides detailed information regarding system information, code tables, scenarios, data elements, etc.
Please note: By clicking the link above you will be leaving the MWCB website.

Other Claims Information

Claims EDI Error List (Excel Spreadsheet) - This list contains all of the active errors that can appear on a FROI or SROI acknowledgement report.

FROI Crosswalk (PDF) - The FROI crosswalk is a copy of the paper FROI with IAIABC data element numbers corresponding to each box number of the paper FROI.

SROI Crosswalk (PDF) - The SROI crosswalk is a copy of the paper Notice of Controversy (NOC) form with IAIABC data element numbers corresponding to each box number of the paper NOC form.

Frequently Asked Questions about EDI Claims